Ralph DiClemente
Ralph DiClemente
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Professor of Social and Behavioral Sciences
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Professional overview
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Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health. He earned his undergraduate degree at the City University of New York.
Dr. DiClemente’s research has four key foci:
- Developing interventions to reduce the risk of HIV/STD among vulnerable populations
- Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
- Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
- Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.
He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.
Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.
Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University. He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.
Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine. He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.
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Education
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BA, The City College of the City University of New York (CCNY), New York, NYScM, Behavioral Sciences, Harvard University, Cambridge, MAPhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CAPostdoctoral Fellow, University of California, San Francisco, CA
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Areas of research and study
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Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
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Publications
Publications
Efficacy of an HIV intervention in reducing high-risk human papillomavirus, nonviral sexually transmitted infections, and concurrency among African American women: A randomized-controlled trial
AbstractWingood, G. M., DiClemente, R. J., Robinson-Simpson, L., Lang, D. L., Caliendo, A., & Hardin, J. W. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S36-S43AbstractObjective: This trial evaluated the efficacy of an HIV-intervention condition, relative to a health-promotion condition, in reducing incidence of nonviral sexually transmitted infections (STIs; Chlamydia, gonorrhea, and trichomoniasis), oncogenic human papillomavirus (HPV) subtypes 16 and 18, sexual concurrency, and other HIV-associated behaviors over a 12-month period. Design: Randomized-controlled trial. Data analysts blinded to treatment allocation. Setting: Kaiser Permanente, GA. Subjects: A random sample of 848 African American women. Intervention: The two 4-hour HIV intervention sessions were based on Social Cognitive Theory and the Theory of Gender and Power. The intervention was designed to enhance participants' selfsufficiency and attitudes and skills associated with condom use. The HIV intervention also encouraged STI testing and treatment of male sex partners and reducing vaginal douching and individual and male partner concurrency. Main Outcome Measure: Incident nonviral STIs. Results: In generalized estimating equations' analyses, over the 12-month follow-up, participants in the HIV intervention, relative to the comparison, were less likely to have nonviral incident STIs (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.40 to 0.96; P = 0.033) and incident high-risk HPV infection (OR = 0.37; 95% CI: 0.18 to 0.77; P = 0.008) or concurrent male sex partners (OR = 0.55; 95% CI: 0.37 to 0.83; P = 0.005). In addition, intervention participants were less likely to report multiple male sex partners, more likely to use condoms during oral sex, more likely to inform their main partner of their STI test results, encourage their main partner to seek STI testing, report that their main partner was treated for STIs, and report not douching. Conclusions: This is the first trial to demonstrate that an HIV intervention can achieve reductions in nonviral STIs, high-risk HPV, and individual concurrency.Efficacy of SISTA South Africa on sexual behavior and relationship control among isiXhosa women in South Africa: Results of a randomized-controlled trial
AbstractWingood, G. M., Reddy, P., Lang, D. L., Saleh-Onoya, D., Braxton, N., Sifunda, S., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S59-S65AbstractBackground: The HIV epidemic has a devastating impact among South African women. The current study evaluated the efficacy of SISTA South Africa, a culturally congruent HIV intervention for isiXhosa women in South Africa, which was adapted from SISTA, an HIV intervention for African American women. Methods: A randomized-controlled trial recruited 342 isiXhosa women aged 18-35 years. Participants were randomized to the general health comparison or the SISTA South Africa intervention. Xhosa-speaking peer health educators tailored the SISTA South Africa curriculum, while maintaining the core elements of the original SISTA intervention. Participants completed assessments at baseline and 6 months follow-up. Results: Relative to participants in the comparison, participants in the HIV intervention reduced the frequency of unprotected vaginal intercourse acts (adjusted mean difference = 1.06; P = 0.02), were more likely to report not desiring dry sex (adjusted odds ratio = 0.229; 95% confidence interval = 0.10 to 0.47; P = 0.0001), and were more likely to perceive that their main sexual partner did not desire dry sex (adjusted odds ratio = 0.24; 95% confidence interval = 0.11 to 0.52; P = 0.0001). In addition, women randomized to the intervention also reported an increase in HIV knowledge, greater relationship control, and had more opposing attitudes toward HIV stigma. The HIV intervention did not reduce sexually transmitted infection incidence. Conclusions: This trial demonstrates that an HIV intervention, which is adapted to enhance its gender and cultural relevance for rural isiXhosa women, can reduce self-reported sexual risk behaviors and enhance mediators of HIV among this vulnerable population.Factors associated with sexual arousal, sexual sensation seeking and sexual satisfaction among female African American adolescents
AbstractSales, J. M., Smearman, E. L., Brody, G. H., Milhausen, R., Philibert, R. A., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
6Page(s)
512-521AbstractBackground: Sexuality-related constructs, such as sexual arousal, sexual sensation seeking (SSS) and sexual satisfaction, have been related to sexual behaviours that place one at risk of adverse consequences, such as sexually transmissible infections, HIV and unintended pregnancy. The biopsychosocial model posits an array of factors, ranging from social environmental factors to biological and psychological predispositions, that may be associated with these sexuality constructs in adolescents. Methods: Female African Americans aged 14-20 years were recruited from reproductive health clinics for an HIV intervention. Baseline survey and follow-up DNA data (n=304) were used to assess biological, psychological and social environmental associations with the sexuality constructs of arousal, SSS and sexual satisfaction. Results: Multivariate linear regression analysis revealed that a higher depressive symptom rating was associated with higher arousability, whereas short serotonin transporter gene allele(s) status was associated with lower arousability. Impulsivity and perceived peer norms supportive of unsafe sexual behaviours were associated with increased SSS, whereas short serotonin transporter gene allele(s) status was associated with lower SSS. Higher social support was associated with higher levels of sexual satisfaction, whereas short serotonin transporter gene allele(s) status was associated with lower satisfaction. The sexuality constructs were also significantly related to the number of sex partners, the frequency of vaginal sex and the number of unprotected vaginal sex acts in the past 6 months. Conclusions: The findings emphasise the importance of understanding biopsychosocial factors, including the role of serotonin as an indicator of natural variations in sexual inclination and behaviours, that influence sexuality constructs, which, in turn, are associated with sexual behaviours, to allow further refinement of sexual health clinical services and programs and promote the development of healthy sexuality. Journal compilationGang Norms and Risky Sex Among Adolescents With a History of Detention
AbstractKing, K. M., Voisin, D. R., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Journal of Social Service ResearchVolume
39Issue
4Page(s)
545-551AbstractPrior studies have examined whether or not belonging to a gang was associated with risky sexual behaviors. However, the literature has yet to explore whether it is not just gang membership but gang norms that are associated with risky sex, which was the primary aim of this study. Audio computer-assisted self-interviewing technology was used to collect data from a convenience sample of 136 adolescent detainees who reported gang involvement. Demographics, gang norms, and risky sexual behaviors occurring in the 2 months prior to being detained were assessed. Multiple logistic regression models controlling for demographics documented that adolescents who reported high-risk gang norms were significantly more likely to: have sex while high on drugs, have sex with a partner who was high on drugs, have group sex, and report condom breakage or leakage during a sexual encounter, compared with those with low-risk gang norms. Results suggest that the norms present within gangs infer added sexual risks. Future research should assess how risk norms differ across various gangs. Sexually transmitted infection prevention approaches should target youth who belong to gangs that promote risky norms given that conventions exist on a continuum.Gender based violence as a risk factor for HIV-associated risk behaviors among female sex workers in Armenia
AbstractLang, D. L., Salazar, L. F., Diclemente, R. J., & Markosyan, K. (n.d.).Publication year
2013Journal title
AIDS and BehaviorVolume
17Issue
2Page(s)
551-558AbstractThis cross-sectional study identified the prevalence of gender based violence (GBV) and examined its association with sexual risk behavior among female sex workers (FSWs). Among 120 participants between ages 20 and 52, a total of 56.7 % reported lifetime GBV. Multivariate analyses revealed that GBV was significantly associated with inconsistent condom use, unprotected sex, condom misuse, fear of client reaction to requests of condom use, self-reported history of STIs, and earlier age of initiation of sex work. GBV must be considered an urgent public health priority among FSWs in Armenia. Interventions addressing FSWs, in addition to targeting skill-based, sexual risk reduction must also introduce a discourse among FSWs, sexual partners, clients and community members about the role of GBV in HIV-associated risk behaviors and infection. Structural level initiatives must address economic opportunities for women, health-sector policies and responses to FSWs' health needs, law enforcement training and societal norms toward women.Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines
AbstractGargano, L. M., Herbert, N. L., Painter, J. E., Sales, J. M., Morfaw, C., Rask, K., Murray, D., Diclemente, R. J., & Hughes, J. M. (n.d.).Publication year
2013Journal title
Human Vaccines and ImmunotherapeuticsVolume
9Issue
12Page(s)
2627-2633AbstractFour vaccines are recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices for adolescents. Parental attitudes may play a key role in vaccination uptake in this age group. In 2011, we conducted a cross-sectional survey among parents of adolescents in one county in Georgia to identify parental attitudes toward adolescent vaccination, reasons for vaccine acceptance or refusal, and impact of a physician recommendation for vaccination. Physician recommendation was reported as one of the top reasons for receipt or intent to receive any of the vaccines. Physician recommendation of any of the four vaccines was associated with receipt of Tdap (p < 0.001), McV4 (p < 0.001), and hPV (p = 0.03) and intent to receive Tdap (p = 0.05), McV4 (p = 0.005), and hPV (p = 0.05). compared with parents who did not intend to have their adolescent vaccinated with any of the vaccines, parents who did intend reported higher perceived susceptibility (3.12 vs. 2.63, p = 0.03) and severity of disease (3.89 vs. 3.70, p = 0.02) and higher perceived benefit of vaccination (8.48 vs. 7.74, p = 0.02). These findings suggest that future vaccination efforts geared toward parents may benefit from addressing the advantages of vaccination and enhancing social norms. Physicians can play a key role by providing information on the benefits of adolescent vaccination.Improving health outcomes for IPV-exposed women living with HIV
Wingood, G. M., Diclemente, R. J., & Seth, P. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
64Issue
1Page(s)
1-2Improving the validity of self-reported sexual behavior: No easy answers
DiClemente, R. J., Swartzendruber, A. L., & Brown, J. L. (n.d.).Publication year
2013Journal title
Sexually Transmitted DiseasesVolume
40Issue
2Page(s)
111-112In their own words: Romantic relationships and the sexual health of young African American women
AbstractMurray, C. C., Hatfield-Timajchy, K., Kraft, J. M., Bergdall, A. R., Habel, M. A., Kottke, M., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Public Health ReportsVolume
128Page(s)
33-42AbstractObjective. We assessed young African American women's understanding of "dual protection" (DP) (i.e., strategies that simultaneously protect against unintended pregnancies and sexually transmitted diseases [STDs]) and how relationship factors influence their use of DP methods. Methods. We conducted 10 focus groups with African American women (n551) aged 15-24 years in Atlanta, Georgia, to identify barriers to and facilitators of their DP use. Focus group participants also completed a brief self-administered questionnaire that assessed demographics and sexual behaviors. We analyzed focus group data by theme: relationships, planning for sex, pregnancy intentions, STD worries, the trade-off between pregnancy and STDs, attitudes toward condoms and contraceptives, and understanding of DP. Results. From the questionnaire, 51% of participants reported that an STD would be the "worst thing that could happen," and 26% reported that being pregnant would be "terrible." Focus group data suggested that most participants understood what DP was but thought it was not always feasible. Relationship factors (e.g., trust, intimacy, length of relationship, and centrality) affected pregnancy intentions, STD concerns, and use of DP. Social influences (e.g., parents) and pregnancy and STD history also affected attitudes about pregnancy, STDs, and relationships. Conclusions. Although participants identified risks associated with sex, a complex web of social and relationship factors influenced the extent to which they engaged in protective behavior. The extent to which relationship factors influence DP may reflect developmental tasks of adolescence and should be considered in any program promoting sexual health among young African American women.Interpersonal- and community-level predictors of intimate partner violence perpetration among African American men
AbstractRaiford, J. L., Seth, P., Braxton, N. D., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Journal of Urban HealthVolume
90Issue
4Page(s)
784-795AbstractIntimate partner violence (IPV) has been associated with adverse physical, psychoemotional, and sexual health, and African American women are at higher risk for experiencing IPV. Considering African American women predominantly have African American male partners, it is essential to identify factors associated with IPV perpetration among African American men. The present study examined attitudes toward IPV, ineffective couple conflict resolution, exposure to neighborhood violence, and the interplay of these factors as predictors of IPV perpetration. A community sample of 80 single, heterosexual, African American men between 18 and 29 years completed measures assessing sociodemographics, attitudes towards IPV, perceived ineffective couple conflict resolution, exposure to neighborhood violence, and IPV perpetration during the past 3 months. Hierarchical multiple linear regression analyses, with age, education, and public assistance as covariates, were conducted on 65 men who reported being in a main relationship. Couple conflict resolution and exposure to neighborhood violence moderated the relation between attitudes supporting IPV and IPV perpetration. Among men who reported high ineffective couple conflict resolution and high exposure to neighborhood violence, IPV perpetration increased as attitudes supporting IPV increased. The findings indicated that interpersonal- and community-level factors interact with individual level factors to increase the risk of recent IPV perpetration among African American men. While IPV prevention should include individual-level interventions that focus on skills building, these findings also highlight the importance of couple-, community-, and structural-level interventions.Interventions to reduce alcohol use among HIV-Infected individuals: A review and critique of the literature
AbstractBrown, J. L., Demartini, K. S., Sales, J. M., Swartzendruber, A. L., & Diclemente, R. J. (n.d.).Publication year
2013Journal title
Current HIV/AIDS ReportsVolume
10Issue
4Page(s)
356-370AbstractAlcohol use disorders are common among HIV-infected individuals and are associated with adverse physiological complications and increased engagement in other health risk behaviors. This paper provides a review and critique of interventions to reduce alcohol use among HIV-infected individuals, including a: (a) synthesis of core intervention components and trial designs; (b) summary of intervention efficacy to reduce alcohol use outcomes; and (c) methodological critique and guidance for future research. We reviewed 14 behavioral interventions that reported on alcohol use outcomes among HIV-infected individuals. Findings were mixed for intervention efficacy to reduce alcohol frequency and quantity. There was limited evidence that interventions reduced binge drinking frequency or alcohol abuse or dependence symptoms. Despite the prevalence of disordered alcohol use among HIV-infected individuals, there is lack of efficacious intervention approaches. Efficacious intervention approaches to reduce alcohol use among HIV-infected individuals are urgently needed.It takes 2: Partner attributes associated with sexually transmitted infections among adolescents
AbstractSwartzendruber, A., Zenilman, J. M., Niccolai, L. M., Kershaw, T. S., Brown, J. L., Diclemente, R. J., & Sales, J. M. (n.d.).Publication year
2013Journal title
Sexually Transmitted DiseasesVolume
40Issue
5Page(s)
372-378AbstractOBJECTIVES: The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention. DESIGN: The design of this study was systematic review. METHODS: We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded. RESULTS: Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI. CONCLUSIONS: Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.Masculinity, condom use self-efficacy and abusive responses to condom negotiation: The case for HIV prevention for heterosexual African-American men
AbstractRaiford, J. L., Seth, P., Braxton, N. D., & Diclemente, R. J. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
5Page(s)
467-469AbstractBackground This study explored the role of masculinity and perceived condom use skills in African-American men's abusive response to female partners' condom requests. Methods: Eighty African-American men aged 18-29 years completed measures on sexual behaviour, responses to condom requests, condom use self-efficacy and other masculine constructs. Men also were tested for sexually transmissible infections. Results: Men's condom use self-efficacy explained 16.5% of the variance in abusive response to condom requests, beyond demographics and masculine constructs. The full model accounted for 63% of the variance. Conclusions: Many HIV interventions with women encourage condom negotiation. Findings highlight the need to address men's condom use skills and masculine norms.Motivations for Secondary Abstinence Among African American Females at Risk for HIV/Sexually Transmitted Infections
AbstractBradley, E. L., Sales, J. M., Elifson, K. W., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Journal of Black PsychologyVolume
39Issue
4Page(s)
355-374AbstractSome sexually experienced African American females abstain from sexual activity for various reasons and periods of time following sexual debut (secondary abstinence), reducing their risk of HIV/sexually transmitted infection (STI) acquisition. However, few studies have sought to understand secondary abstinence motivations. Furthermore, the scope of existing knowledge may be limited by the quantitative approaches employed. Thus, the purpose of this qualitative study was to investigate secondary abstinence motivations among African American females using a grounded theory approach. Interviews were conducted with 20 young women, aged 18 to 23 years, who recently completed a sexual risk-reduction intervention. Motivations for secondary abstinence not identified in previous studies included feeling used for sex, partner infidelity, and abuse or sexual assault. Also, young women were motivated to abstain to focus on improving certain aspects of their lives. Other motivations similar to those previously identified included not being married or in a committed relationship, separation from one's partner, and STI and pregnancy experiences or fears. Insight from this investigation can be used to improve measurement of motivations and to develop and refine HIV/STI interventions for this population.Multi-level factors associated with pregnancy among urban adolescent women seeking psychological services
AbstractLang, D. L., Rieckmann, T., DiClemente, R. J., Crosby, R. A., Brown, L. K., & Donenberg, G. R. (n.d.).Publication year
2013Journal title
Journal of Urban HealthVolume
90Issue
2Page(s)
212-223AbstractThe purpose of this study was to examine the prevalence of pregnancy as well as multi-level factors (i.e., individual, family, and environment) associated with history of pregnancy among a sample of urban adolescent women seeking psychological services. Data were collected from a total of 264 sexually active, 13-18-year-old, adolescent women who participated in a larger HIV prevention study. Adolescents and one participating parent completed an audio computer-assisted self-interviewing survey. A total of 17.4 % of participants reported a history of pregnancy. A multivariable logistic regression model suggests that after controlling for empirically derived sociodemographic and behavioral covariates, absence of father in the home, family support and cohesion, and neighborhood risk were positively related to pregnancy. This study is among the first to examine multi-level factors associated with pregnancy among adolescent women diagnosed with psychological disorders. Consideration of such factors is crucial both in terms of clinical practice and in the design of pregnancy prevention programs. Collaboration between physicians and mental health providers working with adolescent women is crucial and represents an ideal opportunity to promote parental involvement and access to supportive community resources, including pregnancy prevention programs for this vulnerable population of adolescents.Parent-adolescent communication scale
Sales, J. M. D., Milhausen, R. R., & DiClemente, R. J. (n.d.). In Handbook of Sexuality-Related Measures (1–).Publication year
2013Page(s)
139-140Parental human papillomavirus vaccine survey (PHPVS): Nurse-led instrument development and psychometric testing for use in research and primary care screening
AbstractThomas, T. L., Strickland, O. L., DiClemente, R., Higgins, M., Williams, B., & Hickey, K. (n.d.).Publication year
2013Journal title
Journal of nursing measurementVolume
21Issue
1Page(s)
96-109AbstractBackground and Purpose: Human papillomavirus (HPV) vaccine was approved for girls aged 9-24 years in 2006 to prevent HPV infection and cervical cancer. The Parental Human Papillomavirus Survey (PHPVS) was framed on theoretical constructs of the health belief model (HBM) and developed to survey parents regarding their HPV knowledge, attitudes, and intent to vaccinate. Methods: We evaluated the psychometric properties of the PHPVS using classical item analysis and exploratory factor analysis (EFA) among a sample of 200 parents/caregivers. Results: The EFA yielded a 4-factor unidimensional model that explained between 62% and 68% of the total variance depending on the extraction method used. The estimated Cronbach's alpha for the PHPVS was .96. Conclusions: The PHPVS is a reliable measure of HPV knowledge, attitudes, and intent to vaccinate.Partner communication scale
Sales, J. M. D., Milhausen, R. R., & DiClemente, R. J. (n.d.). In Handbook of Sexuality-Related Measures (1–).Publication year
2013Page(s)
137-138Predictors of consistent condom use among young African American Women
AbstractCrosby, R. A., Diclemente, R. J., Salazar, L. F., Wingood, G. M., McDermott-Sales, J., Young, A. M., & Rose, E. (n.d.).Publication year
2013Journal title
AIDS and BehaviorVolume
17Issue
3Page(s)
865-871AbstractThe purpose of this study was to determine the predictive value of selected factors to the consistent use of condoms among high-risk young African American women. A clinic-based, prospective, study of 242 young, African-American women (ages 15-21) was conducted. In multivariate analysis, consistent condom use was predicted by having greater perceptions of condom negotiation self-efficacy, lower fear of negotiating condom use, and having communicated with sex partners (during the recall period) about condom use. Relational variables were predictive of consistent condom use among young African American women. STD/HIV preventive interventions should target these factors, perhaps in dyad-level interventions.Predictors of repeat chlamydia trachomatis and/or neisseria gonorrhoeae infections among african-american adolescent women
AbstractSwartzendruber, A., Sales, J. M., Brown, J. L., Davis, T. L., Diclemente, R. J., & Rose, E. (n.d.).Publication year
2013Journal title
Sexually transmitted infectionsVolume
89Issue
1Page(s)
76-82AbstractBackground Young African-American women have the highest rates of Chlamydia trachomatis and Neisseria gonorrhoeae in the USA. The objective was to identify baseline predictors of repeat chlamydia and/or gonorrhoea infections among African-American adolescent women. Methods Sociodemographic, psychosocial and behavioural data were collected at baseline and every 6 months for 2 years from 701 African-American women (14-20 years) enrolled in an HIV prevention trial. Vaginal swabs were self-collected at each visit and assayed for chlamydia and gonorrhoea using DNA amplification. Among participants testing positive for chlamydia and/or gonorrhoea at baseline, logistic regression analyses assessed baseline predictors of repeat infection. Results Of 618 (88%) participants with ≥1 follow-up assessment, 123 (20%) had a positive chlamydia and/or gonorrhoea test result at baseline; 49 (40%) had a repeat infection during the study period. Of those with a repeat infection, 30 (61%) were positive at one follow-up visit, 18 (37%) at two visits and 1 (2%) at three follow-up visits. Controlling for age and intervention condition, impulsivity (AOR: 1.71, p=0.018) was associated with an increased likelihood, and having a boyfriend (AOR: 0.21, p=0.006) was associated with a decreased likelihood of repeat infection. Conclusions Repeat chlamydia and/or gonorrhoea infections are common among African-American adolescent women. Among young African-American women who test positive for chlamydia and/or gonorrhoea, tailored interventions for more impulsive adolescents and those not in a relationship may reduce risk of repeat infections. Given the high numbers of repeat infections after receipt of an evidence-based intervention, enhanced screening and treatment services for young men may be warranted. Clinical Trials Registration http://www.clinicaltrials. gov (NCT00279799).Preventing HIV among young people: Research priorities for the future
AbstractPettifor, A., Bekker, L. G., Hosek, S., DiClemente, R., Rosenberg, M., Bull, S. S., Allison, S., Delany-Moretlwe, S., Kapogiannis, B. G., & Cowan, F. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S155-S160AbstractObjective: To review the current state of knowledge on the prevention of sexual transmission of HIV in adolescents and to highlight the existing gaps and priority areas for future research. Background: A disproportionate burden of HIV infections falls on adolescents, a developmental stage marked by unique neural, biological, and social transition. Successful interventions are critical to prevent the spread of HIV in this vulnerable population. Methods: We summarized the current state of research on HIV prevention in adolescents by providing examples of successful interventions and best practices, and highlighting current research gaps. Results: Adolescent interventions fall into 3 main categories: biomedical, behavioral, and structural. The majority of current research has focused on individual behavior change, whereas promising biomedical and structural interventions have been largely understudied in adolescents. Combination prevention interventions may be particularly valuable to this group. Conclusions: Adolescents have unique needs with respect to HIV prevention, and, thus, interventions should be designed to most effectively reach out to this population with information and services that will be relevant to them.Racial differences and correlates of potential adoption of preexposure prophylaxis: Results of a national survey
AbstractWingood, G. M., Dunkle, K., Camp, C., Patel, S., Painter, J. E., Rubtsova, A., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S95-S101AbstractObjective: To examine the association between sociodemographic factors, sexual behaviors, and social factors on potential uptake of preexposure prophylaxis (PrEP) among African American and White adult women in the United States. Methods: Participants were recruited through a nationally representative, random-digit dial telephone household survey. Participants comprised a nationally representative, random sample of unmarried African American (N = 1042) and White women (N = 411) aged 20-44 years. Interviews were conducted using computer-assisted telephone interviewing technology. Bivariate and multivariate analyses examined the relationship between sociodemographics, sexual behaviors, and social influences on women's potential uptake of PrEP. Results: In multivariate analyses, women with lower educational status, greater lifetime sexual partners, provider recommendations supportive of PrEP, and peer norms supportive of PrEP use were more likely to report potential PrEP uptake. Racial analyses revealed that compared with White women, African American women were significantly more likely to report potential use of PrEP [adjusted odds ratio (aOR) = 1.76, P ≤ 0.001], more likely to report use of PrEP if recommended by a health-care provider (aOR = 1.65, P ≤ 0.001), less likely to report that they would be embarrassed to ask a health-care provider for PrEP (aOR = 0.59, P ≤ 0.05), and more likely to report use of PrEP if their female friends also used PrEP (aOR = 2.2, P ≤ 0.001). The potential cost for PrEP was identified as a barrier to adoption by both African American and White women. Conclusions: Findings suggest that women at increased risk for HIV, including those with less education and greater number of sexual partners, may be more likely to use PrEP, although cost may serve as a barrier.Rate of decay in proportion of condom-protected sex acts among adolescents after participation in an HIV risk-reduction intervention
AbstractDiClemente, R. J., Brown, J. L., Sales, J. M., & Rose, E. S. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S85-S89AbstractObjective: HIV risk-reduction interventions have demonstrated efficacy in enhancing the proportion of condom-protected sex (CPS) acts among diverse populations. Although postintervention exposure increase in CPS are often observed, there is scant empirical data quantifying decay of intervention efficacy (declines in CPS after cessation of the intervention among participants reporting an initial postintervention increase in CPS). Thus, the objective of this study was to quantify the rate of decay in intervention efficacy over a 24-month follow-up. Design: African American adolescent females (ages: 14-20; n = 349) completed a baseline audio computer-assisted self-administered interview, participated in an HIV risk-reduction intervention, and were assessed at 6-month intervals for 24 months postintervention. Intervention efficacy was conceptualized as an increase in participants' CPS relative to baseline. Methods: Analyses focused on the subset of participants who reported an initial increase in CPS from baseline to the 6-month postintervention assessment (n = 121) to quantify the rate of decay in intervention efficacy over a 24-month follow-up period. Results: CPS increased markedly from baseline to 6-month followup assessment. However, from 6 to 12 months, a marked decline in CPS was observed. Further CPS declines, though not statistically significant, were observed from 12 to 18 months and 18 to 24 months. Cumulative reductions in CPS over the entire 24-month follow-up resulted in no statistical difference between baseline and 24-month follow-up; indicative of a nonsignificant intervention effect at 24-month assessment. Conclusions: Innovative postintervention optimization strategies are needed to minimize CPS decay over protracted time periods by reinforcing, sustaining, and potentially amplifying initial gains in condom use.Relational correlates of unprotected oral and vaginal sex and among African-American adolescent females
AbstractCrosby, R. A., Voisin, D. R., Diclemente, R. J., Wingood, G. M., Salazar, L. F., Head, S., Rose, E., & McDermott-Sales, J. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
3Page(s)
284-286AbstractObjectivesTo identify relational correlates of unprotected oral sex (UOS) and vaginal intercourse (UVI) among African-American females. Methods: Participants (n≤715) provided data on demographics, sexual communication self efficacy (SCSE), sexual communication frequency, condom self-efficacy, power in sexual relationships, fear of negotiating condom use, UOS and UVI. Results: Participants reporting low SCSE were 2.5 and 1.6 times more likely to report UOS and UVI respectively. Additionally, participants who reported fear of condom negotiation were 3.1 times more likely to report UVI. Conclusions: Interventions promoting stronger SCSE may be a protective factor against having UOS and UVI among African-American females.Reliability and Validity of the Dyadic Observed Communication Scale (DOCS)
AbstractHadley, W., Stewart, A., Hunter, H. L., Affleck, K., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2013Journal title
Journal of Child and Family StudiesVolume
22Issue
2Page(s)
279-287AbstractWe evaluated the reliability and validity of the Dyadic Observed Communication Scale (DOCS) coding scheme, which was developed to capture a range of communication components between parents and adolescents. Adolescents and their caregivers were recruited from mental health facilities for participation in a large, multi-site family-based HIV prevention intervention study. Seventy-one dyads were randomly selected from the larger study sample and coded using the DOCS at baseline. Preliminary validity and reliability of the DOCS was examined using various methods, such as comparing results to self-report measures and examining interrater reliability. Results suggest that the DOCS is a reliable and valid measure of observed communication among parent-adolescent dyads that captures both verbal and nonverbal communication behaviors that are typical intervention targets. The DOCS is a viable coding scheme for use by researchers and clinicians examining parent-adolescent communication. Coders can be trained to reliably capture individual and dyadic components of communication for parents and adolescents and this complex information can be obtained relatively quickly.